DETAILED ACTION
Notice of Pre-AIA or AIA Status
The present application, filed on or after March 16, 2013, is being examined under the first inventor to file provisions of the AIA .
Status of Claims
This is a first office action in response to the applicant’s arguments/remarks filed with an RCE on June 17, 2026.
Claims 1 and 10 have been amended.
Claims 1-18 are pending and have been examined.
Priority
The applicant’s claim for the benefit of a prior-filed application under 35 U.S.C. 119(e) or under 35 U.S.C. 120, 121, 365(c), or 386(c) is acknowledged.
Continued Examination Under 37 CFR 1.114
A request for continued examination under 37 CFR 1.114, including the fee set forth in 37 CFR 1.17(e), was filed in this application after final rejection. Since this application is eligible for continued examination under 37 CFR 1.114, and the fee set forth in 37 CFR 1.17(e) has been timely paid, the finality of the previous Office action has been withdrawn pursuant to 37 CFR 1.114. Applicant's submission filed on 06/27/2026 has been entered.
Responses to Arguments/Remarks
Double Patenting:
The terminal disclaimer, filed on June 17, 2026, disclaiming the terminal part of the statutory term of any patent granted on this application which would extend beyond the expiration date of the full statutory term of US Patent No. 12211036, US Patent No. 11830000, and US Patent No. 11244310, has been reviewed and is accepted. Therefore, the double patenting rejections have been withdrawn.
35 U.S.C. § 101:
The applicant contends that the amended claim 1 is not directed to merely reimbursement processing. Rather, claim 1 as amended recites a specific decentralized computer-network architecture in which a reimbursement claim is validated through distributed consensus among independent pharmacy computer systems before the reimbursement claims may be acted upon by a payer computer system. The examiner respectfully disagrees.
Claim 1 of the instant application recites processing a reimbursement claim. In particular, the claim recites receiving pharmacy data, generating a pharmacy reimbursement data package, transmitting the pharmacy reimbursement data package to a plurality of participants, receiving responses from the participants, determining a validation result, adding an immutable pharmacy entry to a ledger. In other words, the claim falls within the “Certain Methods of Organizing Human Activity” grouping of abstract ideas in Step 2A Prong One (MPEP 2106.04(a)) because the claim involves the steps of processing a reimbursement claim by validating the claim via multiple parties, which is a process related to fundamental economic practices and/or commercial interactions.
The examiner would like to point out that validating a transaction/claim by multiple parties and approving the transaction/claim based on a threshold number of approved responses from the parties are part of the cited abstract idea, which is a process that can mitigate risks of an invalid transaction/claim. Additionally, utilizing a multi-party verification is merely an improvement of the business method itself, but it does not present any improvements in the functioning of a computer or in any other technology or technical field. The recited features in the limitations do not disclose a technical solution to a technical problem, but simply a business solution. Furthermore, validating a transaction/claim by nodes of a distributed network without a central node and storing an immutable entry in a ledger are regular features of the distributed network, such as a blockchain network. The transactions stored in a blockchain are signed and immutable. The nodes of the distributed network can act as validators or not, and the validators perform the validation on a received transaction and reach a consensus. Utilizing the blockchain/distributed network to process different types of transactions has been a common approach. The paragraphs [0021]-[0024] of the specification presented by the applicant merely describe regular features of a validation process based on a distributed network. The improvements claimed by the application based on these paragraphs are merely regular features of a distributed network. Utilizing a distributed network to process a reimbursement claim merely indicates a field of use or technological environment in which the judicial exception is performed. As discussed by the examiner above, validating a reimbursement claim by utilizing multiple parties does not integrate the judicial exception into a practical application because it does not present any improvements in the functioning of a computer or in any other technology or technical field, and it is merely an improvement for the cited abstract idea itself.
The additional elements of computer systems, a computer network, and a pharmacy electronic ledger in claim 1 perform processing a reimbursement claim. These additional elements are recited at a high level of generality such that they amount to no more than mere instructions to apply the exception using generic computer components. Merely adding generic computer components to perform the abstract idea does not integrate the abstract idea into a practical application. Additionally, the computer systems and a computer network are regular computer systems and a regular communication network based on the specification, and they are utilized as tools to perform the steps of processing a reimbursement claim. Those additional elements do not involve improvements to the functioning of a computer, or to any other technology or technical field (MPEP 2106.05(a)); the claim does not apply the abstract idea with, or by use of, a particular machine (MPEP 2106.05(b)); and the claim does not apply or use the abstract idea in some other meaningful ways beyond generally linking the use of the abstract idea to a particular technological environment, such that the claim as a whole is more than a drafting effort designed to monopolize the exception (MPEP 2106.05(e) and Vanda Memo). Therefore, the claim does not, for example, purport to improve the functioning of a computer. Nor does it effect an improvement in any other technology or technical field. Accordingly, the additional elements do not impose any meaningful limits on practicing the abstract idea. Claim 1 as a whole, judging from the additional elements individually and in combination, does not integrate the judicial exception into a practical application. Therefore, claim 1 as a whole fails to recite a practical application of the abstract idea.
The applicant contends that the amended claim 1 recites significantly more than the alleged abstract idea of a method of organizing human activity. The examiner respectfully disagrees.
As discussed by the examiner, validating a transaction/claim by multiple parties and approving the transaction/claim based on a threshold number of approved responses from the parties are part of the cited abstract idea, which is a process that can mitigate risks of an invalid transaction/claim. Additionally, utilizing a multi-party verification is merely an improvement of the business method itself, but it does not present any improvements in the functioning of a computer or in any other technology or technical field. The recited features in the limitations do not disclose a technical solution to a technical problem, but simply a business solution. Using the additional elements to perform the steps of processing a reimbursement claim amounts to no more than using a computer to automate and/or implement the abstract idea. As discussed above, taking the claim elements separately, the additional elements perform the steps or functions that correspond to the actions required to perform the abstract idea. The technical limitations are simply utilized as a tool to implement the abstract idea without adding significantly more. As noted above, the claims do not include additional elements that are sufficient to amount to significantly more than the judicial exception because the additional elements of computer systems, a computer network, and a pharmacy electronic ledger are recited at a high level of generality in such that it results in no more than simply applying the abstract idea using generic computer elements. The additional elements when considered separately and as an ordered combination do not amount to adding significantly more as these limitations provide nothing more than simply applying the exception in a generic computer environment. Therefore, the additional claim elements, when considered individually and in combination, fail to recite significantly more than the abstract idea.
Claim Rejections - 35 USC § 101
35 U.S.C. 101 reads as follows:
Whoever invents or discovers any new and useful process, machine, manufacture, or composition of matter, or any new and useful improvement thereof, may obtain a patent therefor, subject to the conditions and requirements of this title.
Claims 1-18 are rejected under 35 U.S.C. 101 because the claimed invention is directed to an abstract idea without significantly more.
In this instance, claims 1-9 are directed to a method, and claims 10-18 are directed to a system comprising one or more processors and memory. Therefore, claims 1-18 fall within the four statutory categories of invention.
Claim 1 as a whole is directed to processing a reimbursement claim. In particular, the claim recites receiving pharmacy data, generating a pharmacy reimbursement data package, transmitting the pharmacy reimbursement data package to a plurality of participants, receiving responses from the participants, determining a validation result, adding an immutable pharmacy entry to a ledger. In other words, the claim falls under the “Certain Methods of Organizing Human Activity” grouping of abstract ideas in Step 2A Prong One (MPEP 2106.04(a)(d)) because the claim involves the steps for processing a reimbursement claim by validating the claims via multiple parties, which is a process related to fundamental economic practices and/or commercial interactions. More specifically, the following underlined claim elements recite an abstract idea while the non-underlined claim elements recite additional elements according to MPEP 2106.04(a).
Claim 1 recites “[a] decentralized method of initiating reimbursement of pharmacy-related transactions, the method comprising: receiving, at a first pharmacy computer system associated with a first pharmacy, first pharmacy data about a pharmacy transaction between a patient and the first pharmacy, wherein the pharmacy transaction comprises dispensing of a medication by the first pharmacy to the patient; generating, at the first pharmacy computer system, a pharmacy reimbursement data packet based on the first pharmacy data, wherein the pharmacy reimbursement data packet comprises second pharmacy data about a pharmacy reimbursement claim associated with the pharmacy transaction, the second pharmacy data including a quantity of the medication dispensed by the first pharmacy to the patient and a requested pharmacy reimbursement amount for the pharmacy reimbursement claim; transmitting, via a computer network, the pharmacy reimbursement data packet from the first pharmacy computer system to a first payer computer system associated with a first payer and to a plurality of second pharmacy computer systems of a plurality of second pharmacies outside of the transaction and listed in a pharmacy directory; receiving, via the computer network, a pharmacy response from each second pharmacy computer system of the plurality of second pharmacy computer systems, wherein each pharmacy response indicates whether a respective one of the plurality of second pharmacy computer systems determined that the pharmacy reimbursement claim is valid, the pharmacy response of each second pharmacy computer system of the plurality of second pharmacy computer systems being determined based on a pharmacy condition involving the quantity of the medication and on the requested pharmacy reimbursement amount for the pharmacy reimbursement claim; determining a validation result that the pharmacy reimbursement claim is validated based on receiving a threshold number or percentage of the pharmacy responses from the plurality of second pharmacy computer systems validating the pharmacy reimbursement claim; adding an immutable pharmacy entry about the pharmacy transaction, the pharmacy reimbursement claim and the validation result to a pharmacy electronic ledger, the pharmacy electronic ledger being stored by the first pharmacy computer system, the immutable pharmacy entry being cryptographically signed by the first pharmacy computer system; and transmitting, after adding the immutable pharmacy to the pharmacy electronic ledger, at least a portion of the pharmacy electronic ledger that includes the immutable pharmacy entry to the first payer computer system, the immutable pharmacy entry contained in the at least a portion of the pharmacy electronic ledger causing the first payer computer system to initiate processing of the pharmacy reimbursement claim.”
This judicial exception is not integrated into a practical application because, when analyzed under Step 2A Prong Two (MPEP 2106.04(d)), the non-underlined additional elements — computer systems, a computer network, and a pharmacy electronic ledger in claim 1 — perform processing a reimbursement claim. These additional elements are recited at a high level of generality such that they amount to no more than mere instructions to apply the exception using generic computer components. Merely adding generic computer components to perform the abstract idea does not integrate the abstract idea into a practical application. Additionally, the additional element of a pharmacy electronic ledger is only recited as a database for storing data associated with the reimbursement claim. The additional element of the pharmacy electronic ledger stored by the first pharmacy computer system merely describes the characteristics of the identified additional element of the pharmacy electronic ledger. Specifically, computer systems, a computer network, and a pharmacy electronic ledger perform the steps or functions of receiving pharmacy data, generating a pharmacy reimbursement data package, transmitting the pharmacy reimbursement data package to a plurality of participants, receiving responses from the participants, determining a validation result, adding an immutable pharmacy entry to a ledger, and transmitting at least a portion of the ledger. The use of computer components as tools to implement the abstract idea does not integrate the abstract idea into a practical application because it requires no more than a computer performing functions that correspond to acts required to carry out the abstract idea. Those additional elements do not involve improvements to the functioning of a computer, or to any other technology or technical field (MPEP 2106.05(a)); the claim does not apply the abstract idea with, or by use of, a particular machine (MPEP 2106.05(b)); and the claim does not apply or use the abstract idea in some other meaningful ways beyond generally linking the use of the abstract idea to a particular technological environment, such that the claim as a whole is more than a drafting effort designed to monopolize the exception (MPEP 2106.05(e) and Vanda Memo). Therefore, the claim does not, for example, purport to improve the functioning of a computer. Nor does it effect an improvement in any other technology or technical field. Accordingly, the additional elements do not impose any meaningful limits on practicing the abstract idea. Claim 1 as a whole, judging from the additional elements individually and in combination, does not integrate the judicial exception into a practical application. Therefore, claim 1 as a whole fails to recite a practical application of the abstract idea.
Claim 1 does not include additional elements that are sufficient to amount to significantly more than the judicial exception because, when analyzed under Step 2B (MPEP 2106.05), using computer systems, a computer network, and a pharmacy electronic ledger to perform processing a reimbursement claim amounts to no more than mere instructions to apply the exception using generic computer components. Mere instructions to apply an exception using generic computer components cannot provide an inventive concept beyond the recited abstract idea. The additional element of a pharmacy electronic ledger is only recited as a database for storing data associated with the reimbursement claim. The additional element of the pharmacy electronic ledger stored by the first pharmacy computer system merely describes the characteristics of the identified additional element of the pharmacy electronic ledger. As discussed above, taking the additional elements separately, computer systems, a computer network, and a pharmacy electronic ledger perform the steps or functions of receiving pharmacy data, generating a pharmacy reimbursement data package, transmitting the pharmacy reimbursement data package to a plurality of participants, receiving responses from the participants, determining a validation result, adding an immutable pharmacy entry to a ledger, and transmitting at least a portion of the ledger. These functions correspond to the actions required to perform the abstract idea. Viewed as a whole, the combination of elements recited in the claim merely recites the concept of processing a reimbursement claim. Therefore, the additional claim elements, when considered individually and in combination, fail to recite significantly more than the abstract idea.
Accordingly, claim 1 is rejected as being directed toward patent-ineligible subject matter.
Claim 10 recites the abstract idea similar to that discussed above in connection with claim 1. As analyzed above, the additional elements of computer systems, a system comprising one or more processors and memory, a computer network, and a pharmacy electronic ledger are recited at a high level of generality such that they amount to no more than mere instructions to apply the exception using generic computer components. The additional element of the pharmacy electronic ledger stored by the first pharmacy computer system merely describes the characteristics of the identified additional element of the pharmacy electronic ledger. These additional elements do not integrate the judicial exception into a practical application and fail to recite significantly more than the abstract idea.
Claims 2-9 and 11-18 have also been considered for subject-matter eligibility. However, these claims fail to recite patent-eligible subject matter for the following reasons:
Claims 2 and 11 recite wherein the receiving of the pharmacy response from each second pharmacy of the plurality of second pharmacies comprises receiving the pharmacy response from each of a selected subset of the second pharmacies listed in the pharmacy directory, which falls under the “Certain Method of Organizing Human Activity” grouping of abstract ideas. The additional elements of computer systems and a system comprising one or more processors and memory are recited at a high level of generality such that they amount to no more than mere instructions to apply the exception using generic computer components. These additional elements do not integrate the judicial exception into a practical application and fail to recite significantly more than the abstract idea.
Claims 3 and 12 recite an additional element of wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonably relative to the quantity of the medication. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy condition included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 4 and 13 recite an additional element of wherein the pharmacy condition involves a determination whether the requested pharmacy reimbursement amount is reasonably relative to the quantity of the medication. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy condition included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claim 5 and 14 recite an additional element of wherein the pharmacy condition involves a determination whether the medication is normally prescribed by doctors. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy condition included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 6 and 15 recite an additional element of wherein the pharmacy condition involves a determination whether a historical amount of the medication being dispensed by the first pharmacy is within an expected range, the expected range being calculated from an analysis of transactions on the pharmacy electronic ledger. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy condition included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 7 and 16 recite an additional element of wherein the plurality of second pharmacy computer systems includes all of the second pharmacy computer systems associated with a pharmacy listed in the pharmacy directory. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the plurality of second pharmacy computer systems. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 8 and 17 recite an additional element of wherein the pharmacy directory can be modified to add or remove particular second pharmacy computer systems. The additional element fails to recite patent-eligible subject matter as it simply describes the characteristics of the pharmacy directory included in the abstract idea. The additional element is insufficient to integrate the abstract idea into a practical application and does not offer significantly more than the abstract idea because the additional element merely recites additional instructions to implement the abstract idea.
Claims 9 and 18 recite wherein the at least validated pharmacy reimbursement claim contained further causes a second payer system to initiate processing of a wholesaler reimbursement claim, which falls under the “Certain Method of Organizing Human Activity” grouping of abstract ideas. The additional element of a pharmacy electronic ledger is recited at a high level of generality such that it amounts to no more than mere instructions to apply the exception using a generic computer component. Additionally, the additional element of a pharmacy electronic ledger is merely recited as a database for storing data associated with the reimbursement claim. The additional element does not integrate the judicial exception into a practical application and fails to recite significantly more than the abstract idea.
Conclusion
The prior art, made of record and not relied upon, is considered pertinent to the applicant’s disclosure.
Rowe, III et al. (US 8489411 B1) discloses a method of auditing claim reimbursement transactions to ensure that pharmacy benefit management (PBM) services properly calculate the appropriately spread values and honor existing contractual obligations with health plans and/or employer groups. A pharmacy POS device receives prescription claim data, generates a claim reimbursement package including the quantity of medication and the cost, and transmits the generated claim reimbursement package to a host server. The host server forwards the received claim reimbursement package to a PBM and/or a payer system. The PBM and/or payer system may validate the claim and return an authorization or rejection message back to the host server.
Witchey (US 20150332283 A1) discloses a transaction validation system of processing all kinds of healthcare transactions between a patient and another entity, e.g., a doctor, an insurance company, or a pharmacy. Healthcare transactions associated with the patient are compiled into a chain of transaction blocks. When a transaction is conducted, the corresponding healthcare parameters are sent to one or more validation devices. The one or more validation devices could be peers associated with other entities, such as a payer system. The validation devices establish validity of the transaction based on the consensus, and a new block is generated by a trust peer or an authenticator computer. Once the new block has been created, it can be appended to the healthcare blockchain. The new block may include a digital signature of the entity that generates the new block.
Johnsrud et al. (US 20170243177 A1) discloses embodiments that enable a system operatively connected with a blockchain network to use the blockchain for routing of process authorization and settlement based on specified parameters. Rules may be established to ensure the validity of a transaction. A signed transaction record/request placed on the blockchain initiates execution of the transaction validation rules and, once a predetermined threshold number of validation nodes have agreed that the transaction validation has been satisfied, the transaction may be settled. The validation nodes can be adjusted based on the validation requirements.
Jiang et al. (CN 105488665 A) discloses a method of processing decentralized transactions. A first node receives a transaction and may send the transaction to one or more trusted nodes that are included in a trust-node list. The transaction is considered to be validated if the number of confirmations from the one or more trusted nodes exceeds a predefined threshold.
Tanner et al. (US 20170039330 A1) discloses a decentralized autonomous healthcare economy platform. The Health Blockchain itself is organized as a distributed database of data blocks, or replicated shared ledger, in a constantly growing linked list, where each block is cryptographically verified by multiple nodes on the network. A sender of a transaction creates conditions that actors in a system must meet in order to claim the output. In this way any automated system of checks, authorizations, actions or even external events can be involved and validated as part of the transaction.
Gong (US 20130311370 A1) discloses transmitting a transaction to one or more entities based on a routing rule and receiving confirmation from the one or more entities.
Tu et al. (US 20120089847 A1) discloses transmitting an authorization request to one or more devices associated with one or more authorizers on a list, receiving an authorization response from the one or more devices, and determining whether a predetermined level of authorization is received.
Dooley et al. (US 20060212318 A1) discloses reimbursing prescription fulfillment that includes identifying a drug associated with a claim submitted by a pharmacy for reimbursement by a payer and identifying a change in a manufacturer set price associated with the drug. The invention includes monitoring reimbursed claims received from at least one payer, where one of the reimbursed claims received from the payer is associated with the drug, and determining if the payer has updated the internal pricing value associated with the drug. The invention further includes generating a report that includes the payer's updated internal pricing value associated with the drug, and/or creating and submitting a reversal transaction to the at least one payer followed by a resubmission of the original claim.
Thomas et al. (US 20160224949 A1) discloses resolving transactions in a consensus payment network comprising a plurality of nodes. A payer computer system comprises a ledger for the payer and a payee computer system comprises a ledger for the payee. A temporary consensus subnetwork comprising a set of validation nodes is identified as acceptable to the payer system and the payee system. A transaction from the payer to the payee is processed based on a determination of consensus from the consensus subnetwork.
Harris et al. (US 10423759 B1) discloses that an adjudicated response to a healthcare transaction for a product or service for a patient is received and includes a transaction submission time, and transaction comparison data. The transaction comparison data can be compared with a multitude of transaction records of previously processed healthcare transactions to identify a match. The transaction submission time for each of the received healthcare transactions and stored healthcare transactions can be received and compared with one another to determine a submission time difference between the submission time for the healthcare transaction and the stored healthcare transaction. The submission time difference can be compared with a time limit threshold to determine if the difference satisfies the time limit threshold. Based on the determination that the submission time difference satisfies the threshold, the received healthcare transaction can be determined to be a request for a service, such as prior authorization assistance.
Cedergreen (US 10373255 B1) discloses maintaining pharmacy provider networks. A pharmacy provider network is associated with the prescribed drug based on, at least in part, classifying the prescribed drug. It is determined that a pharmacy associated with the claims adjudication data is included within the pharmacy provider network associated with the prescribed drug. As part of the adjudication, the client may ultimately reimburse the pharmacy for filling the prescribed drug when the prescription drug claim was successfully adjudicated. A database may store different types of data, and may be deployed, in whole or in part, on a plurality of devices. Each of the plurality of devices may include a pharmacy provider network subsystem. Part or all of the functionality of the pharmacy provider network subsystem may be provided by the pharmacy device, by the pharmacy benefit manager device, and/or by other devices.
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/CHUNLING DING/Primary Examiner, Art Unit 3699
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